Ataxia

Introduction

Ataxia is defined as impaired balance and poor coordination of intentional movements, resulting in unsteady gait. Most often arrising from cerebellar dysfunction. The acute onset of ataxia, although rare, is very frightening to parents and children and must be evaluated quickly. Most cases are benign and self-limiting, however many different etiologies of ataxia exist making a careful history and physical imperative.

History

Onset. Was it acute or are the symptoms chronic? Any similar past history?

Has there been fever, vomiting, headaches, or lethargy?

Has there been a recent viral illness? Any healing scars from chickenpox?

Is the child taking any medications?

Ask about possible ingestions

Has the child been depressed?

Has there been a history of convulsions?

Has there been a recent ear infection?

Has there been any changes in the child's speech?

Developmental history

Steatorrhea?

Has there been increased number of infections of the upper respiratory tract?

Post-infectious (more common than infectious) Common 2-3 week following chickenpox. Also may be other viruses including Enteroviruses, and influenza. Child's gait most often affected. Majority of cases recover fully. Imaging of CNS is normal. Initial CSF has wbcs and later will develop protein elevation. Includes ADEM (Acute Disseminated Encephalomyelitis) a rare inflammatory demyelinating disease.

Evaluation

Neuroimaging, MRI preffered over CT for posterior fossa due to bone artifact in CT

Treatment

Treatment obviously varies widely depending on etiology. Early intervention is vital in cases associated with increased intracranial pressure, acute infeciton or cerebrovascular accident. Other cases require careful evaluation to rule out other processes. With proper evaluation most cases will require nothing more than continued monitoring with supportive therapy.

Reference

Dunn D. and Patel H. Ataxia: From the benign to the ominous. Contemporary Pediatrics July 1991